Historically, alcohol and tobacco use has been the main substance use for Pacific people in New Zealand (NZ).1,2,3 However, more recently, illicit drug use is a new emerging concerning trend amongst Pacific people in New Zealand. Illicit drugs refer to highly addictive and illegal substances such as cannabis, synthetic cannabinoids, heroin, marijuana and methamphetamine. Importantly, Pacific youth have been identified as having higher prevalence rates than other age groups in the Pacific population in New Zealand. 4 Although, Pacific people have higher rates of substance abuse, they tend to have lower rates of accessing health service access compared with the New Zealand general population.5 Very little research has examined illicit drug use for Pacific people. With the emergence of rising illicit drug use, there is an urgent needed to identify why illicit drugs will become an issue for Pacific people in the future.
Testicular cancers are particularly treatable neoplasms, with five-year survival over 95%.1 An increasing proportion of testicular tumours are seminomas, at the expense of non-seminomas, and the age at time of presentation is also increasing.2 Seminomas are particularly likely to present with localised disease, approximately 80% present with disease limited to the testicle, and less than 5% spread beyond the retroperitoneal nodes at presentation.1
Migrant and refugee youth (MRY) in Australia face specific experiences that inform their sexual and reproductive health and rights (SRHR). Migrant and refugee communities experience poor health outcomes and low service uptake. Additionally, youth are vulnerable to poor sexual health. This review examines the understandings and perspectives of MRY. A systematic review was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol is registered with PROSPERO: CRD42021241213. Nine databases were systematically searched. Inclusion criteria specified literature reporting on migrant and/or refugee youth perspectives and attitudes towards sexual and reproductive health; peer-reviewed qualitative, mixed-methods and/or quantitative studies or grey literature reports; records using Australian research; literature published in English between January 2000 and March 2021. Records that did not report on MRY and did not examine participant views or perspectives; were abstract-only, reviews, pamphlets, protocols, opinion pieces or letters; did not include Australian research; were published before 2000 and/or in a language other than English were excluded. Two reviewers screened titles, abstracts and full-text articles. The Mixed Method Appraisal Tool was used to assess studies’ methodological quality. Thematic synthesis methods guided data extraction and analysis. Twenty-eight papers were included in the final review. Three themes were identified in MRY constructions of SRHR: (1) experiences of silence and shame; (2) understandings of and responses to SRHR risks; (3) navigation of relationships and sexual activity. Socioecological factors shaped MRY perspectives at individual, interpersonal, institutional and societal levels. Societal factors and interpersonal relationships significantly influenced decision making.
The annual Pasifika Medical Association (PMA) Conference was held at the Te Papa Museum, Wellington from the 4th to the 6th of September 2022. The Pasifika Medical Association celebrated 26 years of successful navigation and the conference with a theme of ‘Reconnect, Reflect, Reframe and Reenergise’ was attended by about 500 participants. Most were Pacific health workers from across the Pacific Islands, New Zealand and Australia. Abstracts from the Conference are published here.
Aim: By employing a multi-faceted approach in the disciplines of Theology and Pacific Studies; three key areas of investigation were examined and included: how young Pacific women perceived images of God and faith; how it impacted upon their mental resilience and their responses to mundane and significant life events; and their personal constructs of mental wellbeing. Method: Qualitative group interviews (talanoa) were conducted with participants aged between 17-24 years old; identified with multiple ethnicities, with at least one being Pacific; identified as Roman Catholic, with varying degrees of faith practice; and were based in Auckland, Aotearoa. The Praxis Model methodology was employed throughout the research process and speaks to the interdisciplinary nature of the project. The theory of Intersectionality was utilized as the lens to view each research participants’ multi-layered self-identities. Findings: There were a total of 64 research participants. Out of the 64 participants, 82% (n=52), generally agreed that their image of God aided a positive state of mental wellbeing, five women were unsure and six stated, that it was something else in their faith practice which primarily supported their mental wellbeing. Part of the reason women felt their image of God offered hope for their future, derived from their belief in an afterlife beyond physical death, which they felt, reduced anxiety about their family members who had died or experienced sickness and trauma throughout their lives Conclusions: There is a need for more denomination-specific and culturally responsive foci around mental wellbeing, therefore recognising the unique experiences of faith traditions and the challenges faced, particularly, by multi-ethnic young Pacific women. Key words: Mental wellbeing, Pacific, Theology
Introduction: Autism is a lifelong neurodevelopmental condition that is estimated to impact 1 in 44 children. In Aotearoa New Zealand, the rate of autism among Pasifika children and young people (38.6 per 10,000 people) is substantively lower than other ethnic groups (67.5 for European and 47.2 for Māori); however, the complexities associated with Autism diagnosis in Pasifika is unknown. Aim: We compared rates of Autism and co-occurring diagnoses of conditions as a proxy for Autism case complexity between Pasifika and NMNP young people (aged 0-24 years) in Aotearoa New Zealand. Methods: This national, cross-sectional study was undertaken using data from a national database; the Integrated Data Infrastructure (IDI). Three separate indicators were created to reflect different types of complexity for someone with autism: Asperger’s syndrome (identifies those with lower complexity with fewer demands on support services); intellectual disability (higher needs/greater complexity); ORS funding (higher needs/greater complexity). Findings: In this present study, Pasifika in Aotearoa New Zealand had much lower autism identification rates in comparison to Non-Māori Non-Pasifika (NMNP) (53.3 per 10,000 vs 83 per 10,000). After adjusting for socioeconomic differences, Pasifika had significantly lower odds (Odds Ratio (OR) = 0.47) of having an Asperger’s syndrome diagnosis. However, Pasifika had significantly higher odds of having an intellectual disability (OR = 2.23) and being Ongoing Resources Scheme funded (OR = 2.18). Conclusions: Using this method within the IDI, Pasifika children in Aotearoa continue to have lower rates of Autism diagnosis; however, they are more likely to have a higher complexity of autism diagnosis.
ABSTRACT Introduction: The level of obesity among the Samoan adult population has doubled since 1978 for both men and women and is a serious public health issue. Aim: To determine the knowledge, attitude and practice (KAP) with regard to obesity among Samoan health professionals. Methods: Interview front-line health workers in ten rural and one urban health facility using a developed questionnaire and observation of clinical practice. The sample comprised 130 (68%) registered nurses, 45 (24%) enrolled nurses and 15 (8%) doctors. Findings: Most participants were well informed about the relation between obesity and non-communicable disease and were aware of the prevalence of obesity and related health risks. Contradictory advise was often given to patients about the maintenance of a healthy body weight Discussion: There is a need to educate health workers on evidence-based weight management pathways and to develop patient care plans so overweight and obese persons attending health service facilities are informed effectively on how to lose weight.
Introduction The (traditionally influenced) consumption of kava (Piper methysticum) has been associated with increased body sway, raising concerns about fall risk. However, studies typically utilise pill-styled kava extracts with a lack of understanding regarding experienced naturalistic kava drinkers. This pilot study investigated the effects of naturalistic kava consumption over a six-hour period on postural control. Methods Six experienced male kava drinkers consumed 100ml of kava every 10 minutes over six hours in a culturally responsive setting. Postural control was examined at three time points (Pre, Mid, and Post) using a 30-seconds eyes-closed feet-together postural balance test conducted on a 3D force plate. Centre of pressure path length, average velocity, and area of the 95th percentile ellipse data were extracted and compared between time points using a one-way repeated measures ANOVA. Findings There were no significant differences in the centre of pressure parameters. Based on the Pre and Post differences for path length and average velocity logged values, this study would require 19 participants to achieve an 80% power and 5% significance level. Discussion Irrespective of limited sample size, our preliminary results do not support that kava consumption negatively affects postural control, findings that appear to be corroborated by a recent neuroscience study. The perceived risks of naturalistic kava consumption with regards to falls may be overstated. Further study on the physiological implications of kava consumption in naturalistic settings is needed to quantify the actual risks. Highlights• Kava is a culturally significant drink for Pacific people• Anecdotal reports describe impaired balance following high traditional use volumes• Postural control was tested during and following kava use in a pilot study• Contrary to hypothesis, results do not show that kava negatively affects postural control
Introduction: It is estimated that in the Pacific region the unmet need for family planning is among the highest in the world. This study supports access to family planning based on evidence that impacts of contraceptive use range from improved health to socioeconomic benefits and sustainable development. This study hears from health workers providing essential family planning care to women and their families in Guadalcanal, Solomon Islands. This region was chosen for this study as it has a subnational disparity of highest unmet need for family planning in the Solomon Islands. The aim was to understand health workers’ perspectives on barriers to contraception in this region, and to hear their proposed solutions. Methods: This mixed methods study was based on an exploratory descriptive research approach using a survey, which was distributed to health workers at rural and urban health centres in Guadalcanal, Solomon Islands. Fifty-six surveys comprised of 32 questions, both open and closed-ended, were completed and analysed. This included three demographic questions. Findings: Health workers identified multiple structural, social, and service-driven barriers to meeting the contraceptive needs of women in their communities. Structural barriers include gender inequity and religious influence. Social and service barriers that may be more amenable to influence include misinformation and fear about contraceptive side effects; contraceptive stigma; and access to contraceptive training and education for health workers. Health workers expressed eagerness to address the unmet need for contraception in their communities and are a resource that should be prioritised in programmes seeking to expand access to contraception in the Solomon Islands. Health workers are embedded in their communities and insightful about health service complexities in their settings. They identified solutions including increased access to education and training for Long-Acting Reversible Contraception; increased efforts in raising community awareness and ways of encouraging contraceptive acceptance; and a continued investment in enabling environments both for health workers, and women. Conclusions: This study affirms health workers as a key resource in addressing the unmet need for contraception in Guadalcanal, Solomon Islands, and calls for programme and policy solutions informed by their perspectives. The two main priorities they emphasised to help tackle the persistent problem of unmet need for contraception are an increase in their capability to provide contraceptive implants, and an increase in community education to boost acceptance of family planning care from women and their families.
Aim The prevalence of Type 2 diabetes in Samoa has increased substantially over the last 30 years. Identifying common symptoms in those living with diabetes may be instrumental in directing those at risk to seek early evaluation, diagnosis, and treatment. Additionally, identifying associations between diabetes experiences and health-related quality of life is useful for understanding the lived experience of having diabetes in this setting. Here we present the first description of diabetes-related symptoms in an adult cohort of Samoans with diabetes and prediabetes and describe associations between symptom presence and sex, glycemic control (HbA1c ≥ 8.0%), and health-related quality of life (HRQL). We also assessed whether reported symptoms were independently associated, when adjusting for other factors, with increased odds of having diabetes. METHODS Analyses were conducted on n = 123 adult Samoan participants selectively sampled from the observational cohort Soifua Manuia study, and who were living with either prediabetes or diabetes. Participants completed a series of anthropometric, biochemical, and questionnaire measures including the Revised Diabetes Symptoms Checklist (DSC-R) questionnaire between 2017-2019. Differences in symptom presence by sex, diabetes status (prediabetes vs. diabetes), glycemic control (HbA1c < or ≥ 8.0%), and HRQL were assessed using Independent Sample T-tests, Mann Whitney U tests and Chi-square tests of association. Multivariate logistic regression was used to assess which symptoms, when controlling for other factors, were associated with increased odds of having diabetes. RESULTS In a small sample of adult Samoans, we observed high symptom burdens among those with prediabetes and diabetes, and sex differences in the reported impact of diabetes symptoms on health-related quality of life. We identified three specific symptoms – frequent urination, difficulty thinking clearly, and chest/heart pains – that may be useful indicators of diabetes in this setting. DISCUSSION A high prevalence of symptoms was observed among those with prediabetes and among those with diabetes. It is recommended that individuals experiencing any of the measured symptoms seek early evaluation and engage in diabetes self-care behaviors to prevent diabetes-related complications and/or progression to diabetes among those in the early stages of the disease.
Introduction: Digital health technologies are rapidly changing the landscape of how healthcare is being delivered globally.Many international health systems are using digital technology to assist with delivery of information and healthcare, to enable more affordable, accessible, and acceptable care to manage key health priorities pertaining to that population. The key to success for any digital health approach for Pacific and ethnic-specific communities is ensuring digital inclusion is considered alongside the wider influences of health (family, cultural, economic, social, environmental). Digital technology could be the enabler to reduce inequities in health outcomes in some populations. The aim of this paper is to explore how an intergenerational group of tau fifine Niue (Niue women) use digital health tools for health and wellbeing. Methods: Tutala (similar to talanoa in the Samaon language) a culturally appropriate method of conversation with Niue communities was used to guide the research approach with a tau fifine Niue (n=40). Six group tutala were undertaken with tau afine (young women), tau mamatua fifine (mothers), and tau mamatua tupuna fifine (older women). Results: Three overarching themes were identified: (1) convenience of mHealth tools; (2) access to health information and resources; and (3) digital disconnection. There were differences in the adoption and use of digital tools for health-related purposes, which varied from using the internet, text messaging and health monitoring apps. Although tau afine and tau mamatua fifine were more likely to utilise digital health tools, it was clear not all tau mamatua tupuna fifine experienced the same benefits. Conclusion: Supporting digital inclusion, digital skills, and digital health literacy for tau fifine Niue using an intergenerational approach can translate into health benefits for Niue families and communities. As more and more health services turn todigital technology to assist with delivering health information and care, it is critically important digital technology is delivered in an equitable way that benefits all people, including multi-ethnic populations in Aotearoa, New Zealand.
Introduction: Pasifika young people of Aotearoa New Zealand are known to experience higher rates of mental health and addiction conditions (especially anxiety and depression), compared with young non-Māori/non-Pasifika (NMNP). However, there is little information about how well these issues are identified by mental health services. Aim: We compared rates of diagnosis of common mental health and substance use-related conditions between Pasifika and NMNP young people (aged 10-24 years) and examined how these diagnoses varied with deprivation. Method: This national, cross-sectional study was undertaken using 2017/18 fiscal year data from a national database known as the Integrated Data Infrastructure. Specialist mental health service use, hospitalisations and pharmaceutical dispensing for any mental health condition, emotional condition (depression and/or anxiety), substance use-related conditions, and self-harm were examined. Results: A total of 982,305 young people (12.4%, Pasifika and 63.9%, NMNP) were identified. Compared with NMNP, Pasifika young people were significantly less likely to be diagnosed by specialist mental health services with any mental health condition (adjusted Risk Ratio (aRR) = 0.77, 95% CI = 0.75 to 0.78); any emotional condition (aRR= 0.44, 95% Confidence Interval (CI) = 0.43 to 0.45); or to be hospitalised for self-harm (aRR = 0.88, 95% CI = 0.82 to 0.94). However, they were significantly more likely than NMNP to be diagnosed with substance use-related conditions (aRR = 1.68, 95% CI = 1.63 to 1.74). Although the overall rate of mental health issues remained relatively stable across deprivation levels, emotional conditions were much less frequently diagnosed in those with greater deprivation. Discussion: Discrepancies between expected and identified rates of diagnoses of common mental health and substance use-related conditions might indicate different patterns of service access by Pasifika young people, or they may reflect the bias of an inequitable and less than culturally appropriate health system.
If you think having a doctor for a future husband is ideal, think again. Sure, McDreamy is every girl’s dream but you’ll bet your right arm it’s not all fairy tales and rainbows. Blame E.R and Grey’s Anatomy for putting these silly ideas in our pretty heads.
Aim There is concern that gaming by young Pacific people can lead to gambling, but this is unclear. This study looked at whether there was an association between buying a video game loot box and gambling. Methods We conducted an online survey via Facebook of Pacific (mostly Samoan) New Zealand gamers aged between 16-30 years inclusive with a non-Māori, non-Pacific comparison group. The online survey ran from the 21st of April 2020 till the 30th of June 2020 and disseminated via social media (Facebook and Instagram) using email. We tested whether there was any association between buying an in-game loot box with any gambling activity within the last six months among gamers. Results The study included 828 participants with the Pacific group of n=402 and a comparison group of non-Māori, non-Pacific (nMnP, n=426). A typical Pacific gamer played nearly every day for two to five hours at a time. About 25% of gamers had bought a loot box and about a third of gamers had gambled recently. However, there was no association between buying a loot box and gambling (p=0.811) for Pacific, or for non-Māori, non-Pacific (p=0.727). In multiple logistic regression modelling, older age (OR=1.27, 95%CI [1.21,1.33]) was the only predictor of gambling. Conclusions We did not find any association between buying a loot box and gambling. A longitudinal study would ascertain if there was a link between the two.
Background: Despite numerous published prospective studies, evidence to support use of prophylactic incisional negative pressure wound therapy, for obstetric and gynaecologic surgery, is conflicting. Aim: To evaluate if wound-related presentations to hospital were reduced following introduction of a guideline promoting selective use of prophylactic incisional negative pressure wound therapy. Methods: This was an observational cohort study. Electronic medical records were reviewed for all hospital presentations, within 30 days of primary surgery performed by laparotomy, where the responsible clinician was an obstetrician or gynaecologist. Rates of wound complications and costs associated with admission were compared pre- and post-guideline. Results: Among all those who underwent caesarean birth (n = 2788) or gynaecologic laparotomy (n= 263), 5% presented to hospital with SSI, and 1% with non-infected wound problems. No significant reductions in SSI hospital presentations, length of stay, or readmission costs were observed post-implementation. Likewise, no improvements were observed for non-infected wound problems or a composite of SSI and non-infected wound problems. Conclusions: This study does not support the selective approach used to direct prophylactic incisional negative pressure wound therapy. Further studies are required to better individualise risk assessment, and to determine if negative pressure wound therapy can reduce serious morbidity of SSI. When robust evidence is lacking, local outcomes should be evaluated systematically and reviewed before new treatments become standard care.
Yendarra primary school is located in Ōtara Auckland, New Zealand and is comprised of Pasifika and Māori students aged from 5 – 11 years old. The school is notable for its prioritisation of nutrition in its curriculum and policies. Here, we describe the reasoning for, implementation of and impacts of the policy from interviews of staff. Implementation of the ‘water-only’ policy in 2006, was primarily to address behavioural problems. Almost immediately, significant improvements in behaviour were observed. Following this positive experience, school leadership then focussed on improving school nutrition. Initially, most students did not bring lunch or brought unhealthy processed foods. The leadership team undertook a process including clearly communicating with the school community, using positive reinforcement, valuing student agency, and role modelling preferred behaviours to promote water-only and healthy-kai (food) practices in the school. This enabled a transformational change in the school and communities’ values and culture where water and healthy kai became a norm. Fifteen years on the benefits of these policies are wide-ranging, including improved behaviour, better achievement, happy students, better oral health and improved well-being.
Title: Non-Operative Management of Adhesive Intestinal Bowel Obstruction in Children over a 12year Period at Waikato HospitalIntroduction: Post-operative small bowel adhesions causing bowel obstruction is common in adults but is uncommon in the paediatric age group. The incidence of adhesive intestinal obstruction (AIO) requiring surgical intervention ranges between 2-8% in paediatric patients and majority would occur within the first 2 years after surgery. Aim: To review our experience at a tertiary centre in children under 15years who were admitted with adhesive intestinal obstruction over a 12 year time period and to compare this with other international reports Methodology: This retrospective case series study of all paediatric surgical patients (aged between 1-15 years) admitted with adhesive intestinal obstruction to Waikato Hospital over a 12 year time period were identified by ICD-10-AM codes. Their demographic variables, information of previous surgery and the admissions details including particulars of management were tabulated. Results: Out of 66 admissions, 10 were excluded and 56 admissions were analysed. 35 patients were successfully managed non-operatively and 21 patients proceeded for operative management (7 early and 14 late). Of the operative group, 3 underwent bowel resections (2 early and 1 late). There was no statistically significant difference between length of stay (LOS) among patients with non-operative and operative management. There was also no statistically significant difference between LOS among patients with early (≤24 hours) operative management and late (>24 hours) operative management. In assessing secondary aims, statistically significant differences in the time of presentation from initial surgery was noted for patients who underwent appendectomy who trended towards earlier presentation compared to other laparotomies. Conclusion: This study demonstrated that there could still be a role of non-operative management of children with adhesive bowel obstruction but decision on further management should be clearly defined within 24hours to prevent development of complications.
The talanoa reported in this paper explores the way the Manalagi Project – recently funded by the Health Research Council of New Zealand – has been designed to empower the health and wellbeing of our Pacific Rainbow LGBTIQA+ MVPFAFF communities. Community-driven, co-designed and embedded, the Manalagi Project adopts a Pacific-centred holistic approach to wellbeing and research. Positioned at the beginning of its community consultation phase, this talanoa between the two lead researchers, one who is an academic and the other a community practitioner, documents the genealogy of the project embedded in lived experiences and relationality through talanoa. It speaks to the importance and timeliness of the project; the suitability of the research team; and intervenes in conversations around how we can activate Pacific research methodologies and praxis to empower our communities to achieve their health and wellbeing aspirations. The findings from this talanoa demonstrate the criticality in adopting intersectional approaches to understanding the differentiated and contextualised health and wellbeing needs of diverse Pacific communities.
